Compounds for the treatment of metabolic disorders

ABSTRACT

Agents useful for the treatment of various metabolic disorders, such as insulin resistance syndrome, diabetes, polycystic ovary syndrome, hyperlipidemia, fatty liver disease, cachexia, obesity, atherosclerosis and arteriosclerosis are disclosed. Formula (I) wherein n is 1 or 2; q is 0 or 1; t is 0 or 1; R 1  is alkyl having from 1 to 3 carbon atoms; R 2  is hydrogen, halo, alkyl having from 1 to 3 carbon atoms, or alkoxy having from 1 to 3 carbon atoms; A is unsubstituted or substituted phenyl; or cycloalkyl; or a 5 or 6 membered heteroaromatic ring. Alternatively, the agent can be a pharmaceutically acceptable salt of the compound of Formula I.

BACKGROUND OF THE INVENTION

Diabetes mellitus is a major cause of morbidity and mortality.Chronically elevated blood glucose leads to debilitating complications:nephropathy, often necessitating dialysis or renal transplant;peripheral neuropathy; retinopathy leading to blindness; ulceration ofthe legs and feet, leading to amputation; fatty liver disease, sometimesprogressing to cirrhosis; and vulnerability to coronary artery diseaseand myocardial infarction.

There are two primary types of diabetes. Type I, or insulin-dependentdiabetes mellitus (IDDM) is due to autoimmune destruction ofinsulin-producing beta cells in the pancreatic islets. The onset of thisdisease is usually in childhood or adolescence. Treatment consistsprimarily of multiple daily injections of insulin, combined withfrequent testing of blood glucose levels to guide adjustment of insulindoses, because excess insulin can cause hypoglycemia and consequentimpairment of brain and other functions.

Type II, or noninsulin-dependent diabetes mellitus (NIDDM) typicallydevelops in adulthood. NIDDM is associated with resistance ofglucose-utilizing tissues like adipose tissue, muscle, and liver, to theactions of insulin. Initially, the pancreatic islet beta cellscompensate by secreting excess insulin. Eventual islet failure resultsin decompensation and chronic hyperglycemia. Conversely, moderate isletinsufficiency can precede or coincide with peripheral insulinresistance. There are several classes of drugs that are useful fortreatment of NIDDM: 1) insulin releasers, which directly stimulateinsulin release, carrying the risk of hypoglycemia; 2) prandial insulinreleasers, which potentiate glucose-induced insulin secretion, and mustbe taken before each meal; 3) biguanides, including metformin, whichattenuate hepatic gluconeogenesis (which is paradoxically elevated indiabetes); 4) insulin sensitizers, for example the thiazolidinedionederivatives rosiglitazone and pioglitazone, which improve peripheralresponsiveness to insulin, but which have side effects like weight gain,edema, and occasional liver toxicity; 5) insulin injections, which areoften necessary in the later stages of NIDDM when the islets have failedunder chronic hyperstimulation.

Insulin resistance can also occur without marked hyperglycemia, and isgenerally associated with atherosclerosis, obesity, hyperlipidemia, andessential hypertension. This cluster of abnormalities constitutes the“metabolic syndrome” or “insulin resistance syndrome”. Insulinresistance is also associated with fatty liver, which can progress tochronic inflammation (NASH; “nonalcoholic steatohepatitis”), fibrosis,and cirrhosis. Cumulatively, insulin resistance syndromes, including butnot limited to diabetes, underlie many of the major causes of morbidityand death of people over age 40.

Despite the existence of such drugs, diabetes remains a major andgrowing public health problem. Late stage complications of diabetesconsume a large proportion of national health care resources. There is aneed for new orally active therapeutic agents which effectively addressthe primary defects of insulin resistance and islet failure with feweror milder side effects than existing drugs.

Currently there are no safe and effective treatments for fatty liverdisease. Therefore such a treatment would be of value in treating thiscondition.

SUMMARY OF THE INVENTION

This invention provides a biologically active agent as described below.This invention provides the use of the biologically active agentdescribed below in the manufacture of a medicament for the treatment ofinsulin resistance syndrome, diabetes, cachexia, hyperlipidemia, fattyliver disease, obesity, atherosclerosis or arteriosclerosis. Thisinvention provides methods of treating a mammalian subject with insulinresistance syndrome, diabetes, cachexia, hyperlipidemia, fatty liverdisease, obesity, atherosclerosis or arteriosclerosis comprisingadministering to the subject an effective amount of the biologicallyactive agent described below. This invention provides a pharmaceuticalcomposition comprising the biologically active agent described below anda pharmaceutically acceptable carrier.

The biologically active agent in accordance with this invention is acompound of Formula I:

wherein n is 1 or 2; q is 0 or 1; t is 0 or 1; R¹ is alkyl having from 1to 3 carbon atoms; R² is hydrogen, halo, alkyl having from 1 to 3 carbonatoms, or alkoxy having from 1 to 3 carbon atoms; A is phenyl,unsubstituted or substituted by 1 or 2 groups selected from: halo, alkylhaving 1 or 2 carbon atoms, perfluoromethyl, hydroxy, alkoxy having 1 or2 carbon atoms, and perfluoromethoxy; or cycloalkyl having from 3 to 6ring carbon atoms wherein the cycloalkyl is unsubstituted or one or tworing carbons are independently mono-substituted by methyl or ethyl; or a5 or 6 membered heteroaromatic ring having 1 or 2 ring heteroatomsselected from N, S and O and the heteroaromatic ring is covalently boundto the remainder of the compound of formula I by a ring carbon.Alternatively, the biologically active agent can be a pharmaceuticallyacceptable salt of the compound of Formula I.

It is believed that the biologically active agents of this inventionwill have activity in one or more of the biological activity assaysdescribed below, which are established animal models of human diabetesand insulin resistance syndrome. Therefore such agents would be usefulin the treatment of diabetes and insulin resistance syndrome.

DETAILED DESCRIPTION OF THE INVENTION Definitions

As used herein the term “alkyl” means a linear or branched-chain alkylgroup. An alkyl group identified as having a certain number of carbonatoms means any alkyl group having the specified number of carbons. Forexample, an alkyl having three carbon atoms can be propyl or isopropyl;and alkyl having four carbon atoms can be n-butyl, 1-methylpropyl,2-methylpropyl or t-butyl.

As used herein the term “halo” refers to one or more of fluoro, chloro,bromo, and iodo.

As used herein the term “perfluoro” as in perfluoromethyl orperfluoromethoxy, means that the group in question has fluorine atoms inplace of all of the hydrogen atoms.

As used herein “Ac” refers to the group CH₃C(O)—.

Certain chemical compounds are referred to herein by their chemical nameor by the two-letter code shown below. Compound DG is included withinthe scope of Formula I shown above.

DG 2,6-Difluoro-4-(3-(2,6-dimethylbenzyloxy)phenyl)phenol.

As used herein the transitional term “comprising” is open-ended. A claimutilizing this term can contain elements in addition to those recited insuch claim.

COMPOUNDS OF THE INVENTION

In an embodiment of the agent, use, method or pharmaceutical compositiondescribed in the Summary above, n is 1; q is 0; t is 0; R² is hydrogen;and A is phenyl, unsubstituted or substituted by 1 or 2 groups selectedfrom: halo, hydroxy, alkyl having 1 or 2 carbon atoms, perfluoromethyl,alkoxy having 1 or 2 carbon atoms, and perfluoromethoxy. In anembodiment of this invention “A” is 2,6-dimethylphenyl. Examples of suchcompounds include Compound DG.

In an embodiment of the biologically active agent of this invention, theagent is in substantially (at least 98%) pure form.

Reaction Schemes

The biologically active agents of the present invention can be made inaccordance with the following reaction schemes.

The compound of formula I where q is 0 or 1, t is 0 or 1, and n is 1 or2, R¹ is alkyl having from 1 to 3 carbon atoms, and R² is hydrogen,halo, alkoxy having from 1 to 3 carbon atoms, i.e. compounds of formula:

wherein A is described as above, can be prepared via reaction of scheme1.

In the reaction of scheme 1, A, t, n, q, R¹, and R² are as above. P is ahydrolyzable ester-protecting group. X is bromide or iodide.

The compound of formula IV can be synthesized by Suzuki Coupling orusing a Fu protocol by cross-coupling reaction of the compound offormula II with boronic ester of the compound of formula III viareaction of step (a). The reaction is catalyzed by palladium for exampletris(dibenzylideneacetone)dipalladium (0), tetrakis(triphenylphosphine)palladium (0), bis(triphenylphosphine)palladium (II)chloride and the like. The reaction is carried out in the presence of abase for example cesium carbonate, potassium carbonate, sodiumcarbonate, cesium fluoride, potassium fluoride and the like. Generallythe reaction is carried out in solvents for example tetrahydrofuran,1,2-dimethoxyethane, benzene and the like. Generally the reaction iscarried out at temperatures of from 0° C. to reflux. Any of theconditions conventional in Suzuki couplings can be utilized to carry outthe reaction of step (a). The product can be isolated and purified bytechniques such as extraction, evaporation, chromatography, andrecrystallization.

The compound of formula IV can be converted to the compound of formula Ivia reaction of step (b) by deprotecting the protecting group utilizingsuitable deprotecting reagents such as those described in ProtectiveGroups in Organic Synthesis by T. Greene.

If A is phenyl substituted by 1 or 2 groups of hydroxyl, it is generallypreferred to protect the hydroxyl group with the suitable protectinggroup which protects the hydroxyl group throughout the reaction. Thesuitable protecting group can be described in the Protective Groups inOrganic Synthesis by T. Greene.

The protecting group can be deprotected utilizing suitable deprotectingreagents such as those described in Protective Groups in OrganicSynthesis by T. Greene.

The compound of formula II where q is 0 or 1, t is 0 or 1, and n is 1 or2, R¹ is alkyl having from 1 to 3 carbon atoms, R² is hydrogen, halo,alkoxy having from 1 to 3 carbon atoms or alkyl having from 1 to 3carbon atoms and X is bromide or iodide, i.e. compounds of formula:

wherein A is described as above, can be prepared via reaction of scheme2.

In the reaction of scheme 2, A, t, n, q, R¹, and R² are as above. X isbromide or iodide and Y is a leaving group or halide. Y′ is chloro orbromo.

The compound of formula V can be converted to the compound of formula IXvia reaction of step (c) using Mitsunobu condensation of V with VI usingtriphenylphosphine and diethyl azodicarboxylate or diisopropylazodicarboxylate. The reaction is carried out in a suitable solvent forexample tetrahydrofuran. Any of the conditions conventionally used inMitsunobu reactions can be utilized to carry out the reaction of step(c).

The compound of formula IX can also be prepared by etherifying oralkylating the compound of formula V with the compound of formula VII orthe compound of formula VIII as in reaction of step (c). In the compoundof formula VII, Y, include but are not limited to mesyloxy, tosyloxy,chloro, bromo, iodo, and the like. Any conventional method ofetherifying of a hydroxyl group by reaction with a leaving group orhalide can be utilized to carry out the reaction of step (c). Theproduct can be isolated and purified by techniques such as extraction,evaporation, chromatography, and recrystallization.

The compound of formula IX is the compound of formula II where q is 0 or1.

If A is phenyl substituted by 1 or 2 groups of hydroxyl, it is generallypreferred to protect the hydroxyl group with the suitable protectinggroup which protects the hydroxyl group throughout the reaction. Thesuitable protecting group can be described in the Protective Groups inOrganic Synthesis by T. Greene.

The compound of formula III,

wherein P is a hydrolyzable ester protecting group, can be prepared viareaction of scheme 3. In the reaction of scheme 3, P is as above.

In the compound of formula X, the phenol group can be protected viareaction of step (d) by hydrolyzable protecting group such as loweralkanoyl group. The suitable protecting group can be described in theProtective Groups in Organic Synthesis by T. Greene.

The compound of formula XI can be converted to the compound of formulaXII via reaction of step (e) by reducing nitro group to an amino group.Any conventional reducing agent for example Zn, Sn, Fe and acid can beutilized to carry out the reaction of step (e). The compound of formulaXI can also be reduced to the compound of formula XII via hydrogenation.Among the conventional methods of hydrogenation are for example withhydrogen gas in the presence of 10% Pd/C in ethanol, heterogeneouscatalytic transfer hydrogenation using either 1,4-cyclohexadiene orcyclohexene in ethanol and the like. Generally the reaction is carriedout at temperatures of from 0° C. to reflux. Any of the conditionsconventional in such reduction reactions can be utilized to carry outthe reaction of step (e).

The compound of formula XII can be converted to the aryl bromide of theformula XIII via reaction of step (f) by Sandmeyer reaction by reactingthe compound of formula XII with sodium nitrite in 48% HBr and anhydrouscopper bromide. Generally the reaction is carried out at temperatures offrom 0° C. to reflux. Any of the conditions conventionally used inSandmeyer reactions can be utilized to carry out the reaction of step(f).

The compound of formula XIII can be converted to the compound of formulaIII via reaction of step (g) by cross-coupling reaction of the compoundof formula XIII with bis (pinacolato) diboron using catalyst for example[1,1bis(diphenylphosphino)ferrocene]dichloropalladim (II),bis(triphenylphosphine)palladium (II) chloride and the like. Generallythe reaction is carried out utilizing a suitable base for examplepotassium acetate, triethylamine and the like. The reaction is carriedout in conventional solvents such as dioxane, toluene, dimethylsulphoxide and the like. Generally the reaction is carried out attemperatures of from 0° C. to reflux. Any of the conditionsconventionally used in Miyaura borylation reaction can be utilized tocarry out the reaction of step (g). The product can be isolated andpurified by techniques such as extraction, evaporation, chromatography,and recrystallization.

The compound of formula VI, where t is 0 or 1, n is 1 or 2, i.e.compounds of formula:A−(CH₂)_(t+n)—OHand the compound of formula VII, where t is 0 or 1, n is 1 or 2, i.e.compounds of formula:A−(CH₂)_(t+n)—Ycan be prepared via reaction of scheme 4. In the reaction of scheme 4, Ais described as above. Y is a leaving group.

The compound of formula XIV can be reduced to the compound of formula XVvia reaction of step (h). The reaction is carried out utilizing aconventional reducing agent for example alkali metal hydride such aslithium aluminum hydride. The reaction is carried out in a suitablesolvent, such as tetrahydrofuran. Any of the conditions conventional insuch reduction reactions can be utilized to carry out the reaction ofstep (h). The compound of formula XV is the compound of formula VI wheret is 0 and n is 1.

The compound of formula XV can be converted to the compound of formulaXVI by displacing hydroxyl group with a halogen group preferred halogenbeing bromo or chloro. Appropriate halogenating reagents include but arenot limited to thionyl chloride, bromine, phosphorous tribromide, carbontetrabromide and the like. Any conditions conventional in suchhalogenation reactions can be utilized to carry out the reaction of step(i). The compound of formula XVI is the compound of formula VII where tis 0 and n is 1.

The compound of formula XVI can be converted to the compound of formulaXVII by reacting XVI with an alkali metal cyanide for example sodium orpotassium cyanide. The reaction is carried out in a suitable solvent,such as ethanol or dimethyl sulfoxide. Any of the conditionsconventionally used in the preparation of nitrile can be utilized tocarry out the reaction of step (j).

The compound of formula XVII can be converted to the compound of formulaXVIII via reaction step (k) by acid or base hydrolysis. In carrying outthis reaction it is generally preferred to utilize basic hydrolysis, forexample aqueous sodium hydroxide. Any of the conditions conventionallyused in hydrolysis of nitrile can be utilized to carry out the reactionof step (k).

The compound of formula XVIII can be reduced to give the compound offormula XIX via reaction of step (l). This reaction can be carried outin the same manner as described hereinbefore in the reaction of step(h). The compound of formula XIX is the compound of formula VI where tis 1 and n is 1.

The compound of formula XIX can be converted to the compound of formulaXX via reaction of step (m) in the same manner as described hereinbeforein connection with the reaction of step (i). The compound of formula XXis the compound of formula VII where t is 1 and n is 1.

The compound of formula XVI can be reacted with diethyl malonateutilizing a suitable base for example sodium hydride to give thecompound of formula XXI. The reaction is carried out in suitablesolvents, such as dimethylformamide, tetrahydrofuran and the like. Anyof the conditions conventional in such alkylation reactions can beutilized to carry out the reaction of step (n).

The compound of formula XXI can be hydrolyzed and decarboxylatedutilizing sodium hydroxide in suitable solvent, such as ethanol-water togive the compound of formula XXII. Any of the conditions conventional insuch reactions can be utilized to carry out the reaction of step (o).

The compound of formula XXII can be converted to the compound of formulaXXIII via reaction of step (p) in the same manner as describedhereinbefore in connection with the reaction of step (h). The compoundof formula XXIII is the compound of formula VII where t is 1 and n is 2.

The compound of formula XXIII can be converted to the compound offormula XXIV via reaction of step (q) in the same manner as describedhereinbefore in connection with the reaction of step (i). The compoundof formula XXIV is the compound of formula VII where t is 1 and n is 2.The products can be isolated and purified by techniques such asextraction, evaporation, chromatography, and recrystallization.

If A is phenyl substituted by 1 or 2 groups of hydroxyl, it is generallypreferred to protect the hydroxyl group of the compound of formula XIV.The suitable protecting group can be described in the Protective Groupsin Organic Synthesis by T. Greene.

The compound of formula VIII, where t is 0 or 1, n is 1 or 2, q is 1 andY is chloro or bromo, i.e. compounds of formula:A(CH₂)_(t)(N(R¹))_(q)(CH₂)_(n)Ycan be prepared via reaction of scheme 5. In the reaction of scheme 5, Aand Y are described as above.

The compound of formula XXV can be mesylated to furnish the compound offormula XXVI via reaction of step (r). Any conventional conditions tocarry out the mesylation reaction of a hydroxyl group can be utilized tocarry out the reaction of step (r). The compound of formula XXVI can beheated with the compound of formula XXVII to produce the compound offormula XXVIII. Any of the conditions conventional to produce aminoalcohol can be utilized to carry out the reaction of step (s).

In the compound of formula XXVIII, alcohol can be displaced by chloro orbromo by treating the compound of formula XXVIII with thionyl chloride,oxalyl chloride, bromine, phosphorus tribromide, carbon tetrabromide andthe like to produce the compound of formula VIII. Any conventionalmethod to displace alcohol with chloro or bromo can be utilized to carryout the reaction of step (t).

If A is phenyl substituted by 1 or 2 groups of hydroxyl, it is generallypreferred to protect the hydroxyl group of the compound of formula XXV.The suitable protecting group can be described in the Protective Groupsin Organic Synthesis by T. Greene.

The compound of formula V where R² is hydrogen, halo, alkoxy having from1 to 3 carbon atoms or alkyl having from 1 to 3 carbon atoms and X isbromide or iodide, i.e. compounds of formula:

can be prepared via reaction of scheme 6.

In the reaction of scheme 6, P is a protective group.

In the compound of formula XXIX, hydroxyl group can be protected bymeans of forming hydrolyzable protecting group, which protects thehydroxyl group throughout the reaction. The suitable protecting groupcan be described in the Protective Groups in Organic Synthesis by T.Greene. Any conditions conventional in protecting the hydroxyl group canbe utilized to carry out the reaction of step (u).

The compound of formula XXX can be converted to the compound of formulaXXXI via reaction of step (v) by reducing nitro group to an amino group.Any conventional reducing agent for example Zn, Sn, Fe and acid can beutilized to carry out the reaction of step (v). The compound of formulaXXX can also be reduced to the compound of formula XXXI viahydrogenation. Among the conventional methods of hydrogenation are forexample with hydrogen gas in the presence of 10% Pd/C in ethanol,heterogeneous catalytic transfer hydrogenation using either1,4-cyclohexadiene or cyclohexene in ethanol and the like. Generally thereaction is carried out at temperatures of from 0° C. to reflux. Any ofthe conditions conventional in such reduction reactions can be utilizedto carry out the reaction of step (v).

The compound of formula XXXI can be converted to the compound of formulaXXXII by Sandmeyer reaction in one step via preparation of its diazoniumsalt of the compound of formula XXXI using sodium nitrite and HX andsubsequent displacement with a nucleophile for example anhydrous copperbromide, alkali metal iodide such as sodium and potassium iodide and thelike. Generally the reaction is carried out at temperatures of from 0°C. to reflux. Any of the conditions conventionally used in Sandmeyerreactions can be utilized to carry out the reaction of step (w).

The compound of formula XXXII can be converted to the compound offormula V by deprotection of the hydroxyl-protecting group. The suitabledeprotecting reagents can be described in the Protective Groups inOrganic Synthesis by T. Greene.

The product can be isolated and purified by techniques such asextraction, evaporation, chromatography, and recrystallization.

Use in Methods of Treatment

This invention provides a method for treating a mammalian subject with acondition selected from the group consisting of insulin resistancesyndrome, diabetes (both primary essential diabetes such as Type IDiabetes or Type II Diabetes and secondary nonessential diabetes) andpolycystic ovary syndrome, comprising administering to the subject anamount of a biologically active agent as described herein effective totreat the condition. In accordance with the method of this invention asymptom of diabetes or the chance of developing a symptom of diabetes,such as atherosclerosis, obesity, hypertension, hyperlipidemia, fattyliver disease, nephropathy, neuropathy, retinopathy, foot ulceration andcataracts, each such symptom being associated with diabetes, can bereduced. This invention also provides a method for treatinghyperlipidemia comprising administering to the subject an amount of abiologically active agent as described herein effective to treat thecondition. Compounds reduce serum triglycerides and free fatty acids inhyperlipidemic animals. This invention also provides a method fortreating cachexia comprising administering to the subject an amount of abiologically active agent as described herein effective to treat thecachexia. This invention also provides a method for treating obesitycomprising administering to the subject an amount of a biologicallyactive agent as described herein effective to treat the condition. Thisinvention alsoprovides a method for treating a condition selected fromatherosclerosis or arteriosclerosis comprising administering to thesubject an amount of a biologically active agent as described hereineffective to treat the condition. The active agents of this inventionare effective to treat hyperlipidemia, fatty liver disease, cachexia,obesity, atherosclerosis or arteriosclerosis whether or not the subjecthas diabetes or insulin resistance syndrome. The agent can beadministered by any conventional route of systemic administration.Preferably the agent is administered orally. Accordingly, it ispreferred for the medicament to be formulated for oral administration.Other routes of administration that can be used in accordance with thisinvention include rectally, parenterally, by injection (e.g.intravenous, subcutaneous, intramuscular or intraperitioneal injection),or nasally.

Further embodiments of each of the uses and methods of treatment of thisinvention comprise administering any one of the embodiments of thebiologically active agents described above. In the interest of avoidingunnecessary redundancy, each such agent and group of agents is not beingrepeated, but they are incorporated into this description of uses andmethods of treatment as if they were repeated.

Many of the diseases or disorders that are addressed by the compounds ofthe invention fall into two broad categories: Insulin resistancesyndromes and consequences of chronic hyperglycemia. Dysregulation offuel metabolism, especially insulin resistance, which can occur in theabsence of diabetes (persistent hyperglycemia) per se, is associatedwith a variety of symptoms, including hyperlipidemia, atherosclerosis,obesity, essential hypertension, fatty liver disease (NASH; nonalcoholicsteatohepatitis), and, especially in the context of cancer or systemicinflammatory disease, cachexia. Cachexia can also occur in the contextof Type I Diabetes or late-stage Type II Diabetes. By improving tissuefuel metabolism, active agents of the invention are useful forpreventing or amelioriating diseases and symptoms associated withinsulin resistance. While a cluster of signs and symptoms associatedwith insulin resistance may coexist in an individual patient, it manycases only one symptom may dominate, due to individual differences invulnerability of the many physiological systems affected by insulinresistance. Nonetheless, since insulin resistance is a major contributorto many disease conditions, drugs which address this cellular andmolecular defect are useful for prevention or amelioration of virtuallyany symptom in any organ system that may be due to, or exacerbated by,insulin resistance.

When insulin resistance and concurrent inadequate insulin production bypancreatic islets are sufficiently severe, chronic hyperglycemia occurs,defining the onset of Type II diabetes mellitus (NIDDM). In addition tothe metabolic disorders related to insulin resistance indicated above,disease symptoms secondary to hyperglycemia also occur in patients withNIDDM. These include nephropathy, peripheral neuropathy, retinopathy,microvascular disease, ulceration of the extremities, and consequencesof nonenzymatic glycosylation of proteins, e.g. damage to collagen andother connective tissues. Attenuation of hyperglycemia reduces the rateof onset and severity of these consequences of diabetes. Because activeagents and compositions of the invention help to reduce hyperglycemia indiabetes, they are useful for prevention and amelioration of 14complications of chronic hyperglycemia.

Both human and non-human mammalian subjects can be treated in accordancewith the treatment method of this invention. The optimal dose of aparticular active agent of the invention for a particular subject can bedetermined in the clinical setting by a skilled clinician. In the caseof oral administration to a human for treatment of disorders related toinsulin resistance, diabetes, hyperlipidemia, fatty liver disease,cachexia or obesity the agent is generally administered in a daily doseof from 1 mg to 400 mg, administered once or twice per day. In the caseof oral administration to a mouse the agent is generally administered ina daily dose from 1 to 300 mg of the agent per kilogram of body weight.Active agents of the invention are used as monotherapy in diabetes orinsulin resistance syndrome, or in combination with one or more otherdrugs with utility in these types of diseases, e.g. insulin releasingagents, prandial insulin releasers, biguanides, or insulin itself. Suchadditional drugs are administered in accord with standard clinicalpractice. In some cases, agents of the invention will improve theefficacy of other classes of drugs, permitting lower (and therefore lesstoxic) doses of such agents to be administered to patients withsatisfactory therapeutic results. Established safe and effective doseranges in humans for representative compounds are: metformin 500 to 2550mg/day; glyburide 1.25 to 20 mg/day; GLUCOVANCE (combined formulation ofmetformin and glyburide) 1.25 to 20 mg/day glyburide and 250 to 2000mg/day metformin; atorvastatin 10 to 80 mg/day; lovastatin 10 to 80mg/day; pravastatin 10 to 40 mg/day; and simvastatin 5-80 mg/day;clofibrate 2000 mg/day; gemfibrozil 1200 to 2400 mg/day, rosiglitazone 4to 8 mg/day; pioglitazone 15 to 45 mg/day; acarbose 75-300 mg/day;repaglinide 0.5 to 16 mg/day.

Type I Diabetes Mellitus: A patient with Type I diabetes manages theirdisease primarily by self-administration of one to several doses ofinsulin per day, with frequent monitoring blood glucose to permitappropriate adjustment of the dose and timing of insulin administration.Chronic hyperglycemia leads to complications such as nephropathy,neuropathy, retinopathy, foot ulceration, and early mortality;hypoglycemia due to excessive insulin dosing can cause cognitivedysfunction or unconsciousness. A patient with Type I diabetes istreated with 1 to 400 mg/day of an active agent of this invention, intablet or capsule form either as a single or a divided dose. Theanticipated effect will be a reduction in the dose or frequency ofadministration of insulin required to maintain blood glucose in asatisfactory range, and a reduced incidence and severity of hypoglycemicepisodes. Clinical outcome is monitored by measurement of blood glucoseand glycosylated hemoglobin (an index of adequacy of glycemic controlintegrated over a period of several months), as well as by reducedincidence and severity of typical complications of diabetes. Abiologically active agent of this invention can be administered inconjunction with islet transplantation to help maintain theanti-diabetic efficacy of the islet transplant.

Type II Diabetes Mellitus: A typical patient with Type II diabetes(NIDDM) manages their disease by programs of diet and exercise as wellas by taking medications such as metformin, glyburide, repaglinide,rosiglitazone, or acarbose, all of which provide some improvement inglycemic control in some patients, but none of which are free of sideeffects or eventual treatment failure due to disease progression. Isletfailure occurs over time in patients with NIDDM, necessitating insulininjections in a large fraction of patients. It is anticipated that dailytreatment with an active agent of the invention (with or withoutadditional classes of antidiabetic medication) will improve glycemiccontrol, reduce the rate of islet failure, and reduce the incidence andseverity of typical symptoms of diabetes. In addition, active agents ofthe invention will reduce elevated serum triglycerides and fatty acids,thereby reducing the risk of cardiovascular disease, a major cause ofdeath of diabetic patients. As is the case for all other therapeuticagents for diabetes, dose optimization is done in individual patientsaccording to need, clinical effect, and susceptibility to side effects.

Hyperlipidemia: Elevated triglyceride and free fatty acid levels inblood affect a substantial fraction of the population and are animportant risk factor for atherosclerosis and myocardial infarction.Active agents of the invention are useful for reducing circulatingtriglycerides and free fatty acids in hyperlipidemic patients.Hyperlipidemic patients often also have elevated blood cholesterollevels, which also increase the risk of cardiovascular disease.Cholesterol-lowering drugs such as HMG-CoA reductase inhibitors(“statins”) can be administered to hyperlipidemic patients in additionto agents of the invention, optionally incorporated into the samepharmaceutical composition.

Fatty Liver Disease: A substantial fraction of the population isaffected by fatty liver disease, also known as nonalcoholicsteatohepatitis (NASH); NASH is often associated with obesity anddiabetes. Hepatic steatosis, the presence of droplets of triglycerideswith hepatocytes, predisposes the liver to chronic inflammation(detected in biopsy samples as infiltration of inflammatory leukocytes),which can lead to fibrosis and cirrhosis. Fatty liver disease isgenerally detected by observation of elevated serum levels ofliver-specific enzymes such as the transaminases ALT and AST, whichserve as indices of hepatocyte injury, as well as by presentation ofsymptoms which include fatigue and pain in the region of the liver,though definitive diagnosis often requires a biopsy. The anticipatedbenefit is a reduction in liver inflammation and fat content, resultingin attenuation, halting, or reversal of the progression of NASH towardfibrosis and cirrhosis.

Pharmaceutical Compositions

This invention provides a pharmaceutical composition comprising abiologically active agent as described herein and a pharmaceuticallyacceptable carrier. Further embodiments of the pharmaceuticalcomposition of this invention comprise any one of the embodiments of thebiologically active agents described above. In the interest of avoidingunnecessary redundancy, each such agent and group of agents is not beingrepeated, but they are incorporated into this description ofpharmaceutical compositions as if they were repeated.

Preferably the composition is adapted for oral administration, e.g. inthe form of a tablet, coated tablet, dragee, hard or soft gelatincapsule, solution, emulsion or suspension. In general the oralcomposition will comprise from 1 mg to 400 mg of such agent. It isconvenient for the subject to swallow one or two tablets, coatedtablets, dragees, or gelatin capsules per day. However the compositioncan also be adapted for administration by any other conventional meansof systemic administration including rectally, e.g. in the form ofsuppositories, parenterally, e.g. in the form of injection solutions, ornasally.

The biologically active compounds can be processed with pharmaceuticallyinert, inorganic or organic carriers for the production ofpharmaceutical compositions. Lactose, corn starch or derivativesthereof, talc, stearic acid or its salts and the like can be used, forexample, as such carriers for tablets, coated tablets, dragees and hardgelatin capsules. Suitable carriers for soft gelatin capsules are, forexample, vegetable oils, waxes, fats, semi-solid and liquid polyols andthe like. Depending on the nature of the active ingredient no carriersare, however, usually required in the case of soft gelatin capsules,other than the soft gelatin itself. Suitable carriers for the productionof solutions and syrups are, for example, water, polyols, glycerol,vegetable oils and the like. Suitable carriers for suppositories are,for example, natural or hardened oils, waxes, fats, semil-liquid orliquid polyols and the like.

The pharmaceutical compositions can, moreover, contain preservatives,solubilizers, stabilizers, wetting agents, emulsifiers, sweeteners,colorants, flavorants, salts for varying the osmotic pressure, buffers,coating agents or antioxidants. They can also contain still othertherapeutically valuable substances, particularly antidiabetic orhypolipidemic agents that act through mechanisms other than thoseunderlying the effects of the compounds of the invention. Agents whichcan advantageously be combined with 28 compounds of the invention in asingle formulation include but are not limited to biguanides such asmetformin, insulin releasing agents such as the sulfonylurea insulinreleaser glyburide and other sulfonylurea insulin releasers,cholesterol-lowering drugs such as the “statin” HMG-CoA reductaseinhibitors such as atrovastatin, lovastatin, pravastatin andsimvastatin, PPAR-alpha agonists such as clofibrate and gemfibrozil,PPAR-gamma agonists such as thiazolidinediones (e.g. rosiglitazone andpioglitazone, alpha-glucosidase inhibitors such as acarbose (whichinhibit starch digestion), and prandial insulin releasers such asrepaglinide. The amounts of complementary agents combined with compoundsof the invention in single formulations are in accord with the dosesused in standard clinical practice. Established safe and effective doseranges for certain representative compounds are set forth above.

The invention will be better understood by reference to the followingexamples which illustrate but do not limit the invention describedherein.

EXAMPLES Example A Improvement of Metabolic Abnormalities inInsulin-Dependent Diabetes

Streptozotocin (STZ) is a toxin that selectively destroysinsulin-producing pancreatic beta cells, and is widely used to induceinsulin-dependent diabetes in experimental animals.

Female Balb/C mice (8 weeks old; 18-20 grams body weight) are treatedwith streptozotocin (STZ) (50 mg/kg i.p. on each of five consecutivedays). Fourteen days after the last dose of STZ, blood glucose ismeasured to verify that the animals are diabetic, and the mice aredivided into two groups of 5 animals each, one group receiving acompound of the invention (250 mg/kg) daily by oral gavage, and theother receiving vehicle (0.75% hydroxypropylmethylcellulose, asuspending agent, in water). A group of nondiabetic mice from the samecohort that did not receive STZ is also monitored. Blood samples aretaken periodically for determination of blood glucose concentrations,and body weights are also recorded.

After several weeks of treatment, blood glucose concentrations in micetreated orally with the compound of the invention and in vehicle-treatedcontrol animals are measured. A blood glucose concentration beginning todecrease toward baseline is considered a positive result, whereas bloodglucose in the vehicle-treated control animals is expected to continueto rise. Body weights and blood glucose, triglyceride and cholesterolconcentrations 14 weeks after the beginning of drug treatment aremeasured.

Example B Improved Survival of Mice with Lethal Insulin-DependentDiabetes

Female Balb/C mice (14 weeks old) are treated with a single dose ofstreptozotocin (175 mg/kg i.p.) to induce severe insulin-dependentdiabetes. Seven days later, mice are divided into three treatmentgroups: A compound of the invention, pioglitazone, and vehicle. Mice aretreated daily via oral gavage, and survival is monitored over time.

Example C Reduction of Mortality in Severe Insulin-Dependent Diabetes

Female balb/C mice (19 wks of age at start of experiment) are challengedwith multiple high doses of STZ (75 mg/kg i.p. on 5 consecutive days).Animals are then divided in two groups (20 mice/group) matched forseverity of diabetes. Four days after the last dose of STZ, treatmentsare initiated. One group receives Vehicle (0.4 ml of 0.75% HPMC, p.o.),and the other group receives a compound of the invention orally (30mg/kg/day). After three weeks of daily treatment, cumulative mortalityin the two groups is recorded.

Example D Reduction in the Incidence of Spontaneous Diabetes andMortality in Nod Mice

A substantial proportion of NOD (“non-obese diabetic”) mice developinsulin-dependent diabetes as a consequence of spontaneous autoimmunedestruction of pancreatic islet cells. Two groups of 20 NOD mice (6weeks old) are treated daily with either oral Vehicle (0.4 ml of 0.75%hydroxypropyl methylcellulose in water; HPMC) or a compound of theinvention (200 mg/kg/day) suspended in HPMC. The incidence of mortalitydue to spontaneous development of severe insulin-dependent diabetes ismonitored over a period of seven months.

Example E Reduction in Hyperglycemia and Hyperlipidemia, andAmelioration of Fatty Liver Disease in Ob/Ob Obese Diabetic Mice

Ob/ob mice have a defect in the gene for leptin, a protein involved inappetite regulation and energy metabolism, and are hyperphagic, obese,and insulin resistant. They develop hyperglycemia and fatty liver.

Male lean (ob/+heterozygote) and obese (ob/ob homozygote) C57BL/6 miceapproximately 8 weeks of age are obtained from Jackson Labs (Bar Harbor,Me.) and randomly assigned into groups of 5 animals such that bodyweights and blood glucose concentrations are similar between groups. Allanimals are maintained under the control of temperature (23 C), relativehumidity (50±5%) and light (7:00-19:00), and allowed free access towater and laboratory chow (Formulab Diet 5008, Quality Lab Products,Elkridge, Md.). Blood glucose is routinely determined with glucose teststrips and a Glucometer Elite XL device (Bayer Corporation). At selectedtime points, blood samples (˜100 microliters) are obtained with aheparinized capillary tube via the retro-orbital sinus for serumchemistry analysis. Serum chemistry (glucose, triglycerides,cholesterol, BUN, creatinine, AST, ALT, SDH, CPK and free fatty acids)analyses are performed on a Hitachi 717 Analyzer, and plasma insulin andpancreatic insulin are measured by an electrochemiluminescentimmunoassay (Origen Analyzer, Igen, Inc., Gaithersburg, Md.).

Groups of ob/ob mice are divided into treatment cohorts as indicatedbelow, and given daily oral doses of a compound of the invention (10,30, 100, 150 or 300 mg), rosiglitazone (1, 3, 10 or 30 mg), orpioglitazone (30 or 100 mg). The latter two compounds areinsulin-sensitizing drugs used in the treatment of human patients withnon-insulin dependent diabetes mellitus, and are used as comparators forefficacy and safety of compounds of the invention. The dose ranges ofcompounds in this experiment is chosen to include both suboptimal andpotentially supraoptimal doses.

Ob/ob mice develop chronic inflammatory fatty liver disease and areconsidered to be an animal model for nonalcoholic steatohepatitis(NASH), a condition which can lead toward progressive cirrhosis andliver dysfunction. In NASH, fat accumulation increases thesusceptibility of the liver to inflammatory injury. One characteristicsign of NASH in patients is, in the absence of viral infection oralcoholism, elevated levels in serum of enzymes that are released fromdamaged hepatocytes, e.g. alanine aminotransferase (ALT), aspartateaminotransferase (AST), and sorbitol dehydrogenase (SDH). These enzymesare elevated in ob/ob mice as a consequence of fatty liver and secondaryinflammation.

Example F Acute Hypoglycemic Effects of Compounds of the Invention inDiabetic Mice: Experiment 1.

Compounds of the invention display acute antihyperglycemic activity inanimals with non insulin-dependent diabetes.

Male ob/ob diabetic mice are randomized into groups of five animalseach. Body weights are about 50-55 g and blood glucose is approximately300 mg/dL in the fed state. A single oral dose of a test substancesuspended in 0.5% carboxymethylcellulose vehicle is administered bygavage. Blood glucose is measured in blood droplets obtained by nickinga tail vein with a razor using glucometer test strips and a GlucometerElite XL device (Bayer) at 0, 0.5, 2, 4, 6 and 18 hours after theinitial dosing. A 10% reduction in blood glucose versus oral vehicle isconsidered a positive screening result. Blood glucose reductions aregenerally expected to be maximal at 6 hours after drug administration.

Example G Acute Hypoglycemic Effects of Compounds of the Invention inDiabetic Mice: Expt 2

Compounds of the invention display acute antihyperglycemic activity inanimals with noninsulin-dependent diabetes.

Male ob/ob mice (50-55 grams; blood glucose ˜300 mg/dL) are divided intogroups of five animals each, and given a single oral dose of test drug(250 mg/kg) suspended in 0.5% carboxymethylcellulose vehicle; a controlgroup received oral vehicle alone. Six hours after oral administrationof test drugs or vehicle (control), blood samples are obtained from atail vein and glucose content is determined with a glucometer.

Example H Antidiabetic Effects of Compounds of the Invention in Db/DbMice

Db/db mice have a defect in leptin signaling, leading to hyperphagia,obesity and diabetes. Moreover, unlike ob/ob mice which have relativelyrobust islets, their insulin-producing pancreatic islet cells undergofailure during chronic hyperglycemia, so that they transition fromhyperinsulinemia (associated with peripheral insulin resistance) tohypoinsulinemic diabetes.

Male db/db mice are given daily oral treatments with vehicle (0.75%hydroxypropylmethylcellulose), a compound of the invention (150 mg/kg),or pioglitazone (100 mg/kg). Blood samples are obtained via theretro-orbital sinus for serum chemistry analysis, or via the tail veinfor glucose measurement with a test strip and glucometer. The dose ofpioglitazone used in this experiment was reported in the literature tobe a maximally-effective dose for treatment of db/db mice (Shimaya etal. (2000), Metabolism 49:411-7).

In a second experiment in db/db mice, antidiabetic activity of acompound of the invention (150 mg/kg) is compared with that ofrosiglitazone (20 mg/kg). After 8 weeks of treatment, blood glucose andtriglycerides are measured. significantly lower in animals treated witheither Compound BI or rosiglitazone, compared to vehicle-treatedcontrols. The rosiglitazone dose used in this study was reported inpublished literature as the optimum dose for late stage db/db mice(Lenhard et al., (1999) Diabetologia 42:545-54). Groups consist of 6-8mice each.

Example I Antidiabetic Effects of Compounds of the Invention in Db/DbMice

db/db mice have a defect in leptin signaling, leading to hyperphagia,obesity and diabetes. Moreover, unlike ob/ob mice on a C57BL/6Jbackground, db/db mice on a C57BL/KS background undergo failure of theirinsulin-producing pancreatic islet β cells, resulting in progressionfrom hyperinsulinemia (associated with peripheral insulin resistance) tohypoinsulinemic diabetes.

Male obese (db/db homozygote) C57BL/Ksola mice approximately 8 weeks ofage, are obtained from Jackson Labs (Bar Harbor, Me.) and randomlyassigned into groups of 5-7 animals such that the body weights (50-55 g)and serum glucose levels (≧300 mg/dl in fed state) are similar betweengroups; male lean (db/+heterozygote) mice serve as cohort controls. Aminimum of 7 days is allowed for adaptation after arrival. All animalsare maintained under controlled temperature (23° C.), relative humidity(50±5%) and light (7:00-19:00), and allowed free access to standard chow(Formulab Diet 5008, Quality Lab Products, Elkridge, Md.) and water.

Treatment cohorts are given daily oral doses of (1%hydroxypropylmethylcellulose) or a compound of the invention (100 mg/kg)for 2 weeks. At the end of the treatment period 100 μl of venous bloodis withdrawn in a heparinized capillary tube from the retro -orbitalsinus of db/db mice for serum chemistry analysis.

Effects of compounds of the invention on nonfasting blood glucose and onserum triglycerides and free fatty acids are measured.

Example J Attenuation of Cataractogenesis of Compounds of the Inventionin Zucker Diabetic Fatty (ZDF) Rats

Cataracts are one of the leading causes of progressive vision declineand blindness associated with ageing and diabetes, and the Zuckerdiabetic fatty (ZDF) model has many similarities with humancataractogenesis, including biochemical changes and oxidative stress inthe lens. These rats, however, undergo cataractogenesis typicallybetween 14-16 weeks of age.

Male ZDF rats and their aged-match Zucker lean (ZL) counterparts (fa/+or +/+) are obtained from Genetic Models, Inc. (Indianapolis, Ind.) aged12 weeks and acclimatized for 1 week prior to study. All animals aremaintained under controlled temperature (23° C.), relative humidity(50±5%) and light (7:00-19:00), and allowed free access to standard chow(Formulab Diet 5008, Quality Lab Products, Elkridge, Md.) and tap waterad libitum. Treatment cohorts are given a daily oral dose of vehicle and100 mg/kg of a compound of the invention for 10 weeks. Body weights andblood glucose are routinely determined (once a week, usually around10:00 A.M.) from tail bleeds with glucose test strips and a GlucometerElite XL device (Bayer Corporation). At the end of the treatment period100 μl of venous blood is collected (usually 10:00 A.M.) in aheparinized tube from the tail vein for serum chemistry analysis(Anilytics, Inc., Gaithersburg, Md.). Serum chemistry (glucose (GL),triglycerides (TG), aspartate aminotransferase (AST), alanineaminotransferase (ALT), sorbitol dehydrogenase (SDH), and free fattyacids (FFA)) analyses are performed on a Hitachi 717 Analyzer(Anilytics, Inc., Gaithersburg, Md.). Plasma insulin is measured by anelectrochemiluminescent immunoassay, ECL (Origen Analyzer, Igen, Inc.,Gaithersburg, Md.). The animals are sacrificed and tissues and/or organs(lens and liver) are extirpated, weighed (wet weight) and processed forbiochemical analyses. Malondialdehyde (MDA), a major product of lipidperoxidation is assayed in lenses according to Ohkawa et al (1979),Analytical Biochem 95, 351-358).

Example K Lowering of Circulating Triglycerides, Free Fatty Acids,Insulin and Leptin in High Fat-Fed C57B1/6J Mice

The high fat-fed mouse is a model for the hypertriglyceridemia and highcirculating fatty acid levels, and the insulin and leptin resistancethat are found in people at risk for and with obesity, diabetes,cardiovascular disease and other disorders. Male C57B1/6J mice,approximately 8 weeks of age, are randomly assigned into groups of 6animals. They are maintained under controlled temperature (23° C.),relative humidity (50±5%) and light (7:00-19:00), and allowed freeaccess to food and water ad libitum. Mice are fed a high-fat diet (dietnumber D112451, containing 45% of calories as fat (Research Diets, NewBrunswick, N.J.)) for 6 weeks. After the 6 weeks, groups of micereceived either vehicle (hydroxymethylcellulose), a compound of theinvention (10 mg/kg, 30 mg/kg, or 100 mg/kg) Wy14,643 (10 mg/kg, 30mg/kg, or 100 mg/kg) or rosiglitazone (1 mg/kg, 3 mg/kg, 10 mg/kg, or100 mg/kg) by oral gavage for an additional 4 weeks while continuing onthe high-fat diet. Plasma chemistries (Anilytics, Inc., Gaithersburg,Md.) are assayed after 2 weeks of drug treatments. Plasma serum insulinand leptin are measured by an electrochemiluminescent immunoassay(Origen Analyzer, Igen, Inc., Gaithersburg, Md.) after 4 weeks of drugtreatments.

Example L Lowering of Circulating Triglycerides, Free Fatty Acids,Insulin and Leptin in High Fat-Fed Sprague Dawley Rats

The high fat-fed rat is a model for insulin and leptin resistance.Sprague-Dawley rats have an intact leptin system and respond to a highfat diet with hyperinsulinemia due to a downregulation of the normalinsulin response in peripheral tissues such as liver, adipose tissue andmuscle

Male Sprague-Dawley rats, approximately 17 weeks of age, are obtainedfrom Jackson Labs (Bar Harbor, Me.) and randomly assigned into groups of5-7 animals; the body weights are similar between groups. All animalsare maintained in a temperature-controlled (25° C.) facility with astrict 12 h light/dark cycle and are given free access to water andfood. Rats are fed a high-fat diet (diet number D12451 (containing 45%of calories as fat), Research Diets, New Brunswick, N.J.) for one monthprior to drug treatment.

Groups of 6 Sprague-Dawley rats are treated with a single daily dose ofvehicle (hydroxymethylcellulose), a compound of the invention (10, 30and 100 mg/kg), or rosiglitazone (3 mg/kg) for 6 weeks while maintainingthe high-fat diet. Blood samples (˜100 μl) are obtained via the tailvein for serum chemistry analysis.

1. A compound of the formula:

wherein n is 1 or 2; q is 0 or 1; t is 0 or 1; R¹ is alkyl having from 1to 3 carbon atoms; R² is hydrogen, halo, alkyl having from 1 to 3 carbonatoms, or alkoxy having from 1 to 3 carbon atoms; A is phenyl,unsubstituted or substituted by 1 or 2 groups selected from: halo, alkylhaving 1 or 2 carbon atoms, perfluoromethyl, hydroxy, alkoxy having 1 or2 carbon atoms, and perfluoromethoxy; or cycloalkyl having from 3 to 6ring carbon atoms wherein the cycloalkyl is unsubstituted or one or tworing carbons are independently mono-substituted by methyl or ethyl; or a5 or 6 membered heteroaromatic ring having 1 or 2 ring heteroatomsselected from N, S and O and the heteroaromatic ring is covalently boundto the remainder of the compound of formula I by a ring carbon; or apharmaceutically acceptable salt of the compound.
 2. The compound orsalt of claim 1, wherein n is 1; q is 0; t is 0; R² is hydrogen; and Ais phenyl, unsubstituted or substituted by 1 or 2 groups selected from:halo, alkyl having 1 or 2 carbon atoms, perfluoromethyl, hydroxy, alkoxyhaving 1 or 2 carbon atoms, and perfluoromethoxy.
 3. The compound orsalt of claim 2, wherein A is 2,6-dimethylphenyl.
 4. The compound orsalt of claim 3, wherein the compound is2,6-Difluoro-4-(3-(2,6-dimethylbenzyloxy)phenyl)phenol.
 5. Apharmaceutical composition adapted for oral administration, comprising apharmaceutically acceptable carrier and from one milligram to fourhundred milligrams of a biologically active agent, wherein the agent isa compound of the formula:

wherein n is 1 or 2; q is 0 or 1; t is 0 or 1; R¹ is alkyl having from 1to 3 carbon atoms; R² is hydrogen, halo, alkyl having from 1 to 3 carbonatoms, or alkoxy having from 1 to 3 carbon atoms; A is phenyl,unsubstituted or substituted by 1 or 2 groups selected from: halo, alkylhaving 1 or 2 carbon atoms, perfluoromethyl, hydroxy, alkoxy having 1 or2 carbon atoms, and perfluoromethoxy; or cycloalkyl having from 3 to 6ring carbon atoms wherein the cycloalkyl is unsubstituted or one or tworing carbons are independently mono-substituted by methyl or ethyl; or a5 or 6 membered heteroaromatic ring having 1 or 2 ring heteroatomsselected from N, S and O and the heteroaromatic ring is covalently boundto the remainder of the compound of formula I by a ring carbon; or apharmaceutically acceptable salt of the compound.
 6. The pharmaceuticalcomposition of claim 5, wherein n is 1; q is 0; t is 0; R² is hydrogen;and A is phenyl, unsubstituted or substituted by 1 or 2 groups selectedfrom: halo, alkyl having 1 or 2 carbon atoms, perfluoromethyl, hydroxy,alkoxy having 1 or 2 carbon atoms, and perfluoromethoxy.
 7. Thepharmaceutical composition of claim 6, wherein A is 2,6-dimethylphenyl.8. The pharmaceutical composition t of claim 7, wherein the compound is2,6-Difluoro-4-(3-(2,6-dimethylbenzyloxy)phenyl)phenol.
 9. Thepharmaceutical composition of claim 8 in oral dosage form.
 10. Thepharmaceutical composition of claim 5 in oral dosage form.